When each level of government in a decentralized setting pools for a distinct level of health services, then it is organized in a territorially distinct way. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. There are also some concerns, however. But where territorially distinct pools are too small in terms of the number of people, their risk profile can be financially precarious and there could be efficiency and capacity concerns. On the other hand, competition among insurance pools creates an incentive for pool managers to cream skim, i.e. Paris: OECD; 2011. The extent to which the potential redistributive and efficiency gains established by a particular pooling arrangement are realized in practice depends on its interaction and alignment with the other health financing functions of revenue raising and purchasing, including the links between pools and the service benefits and populations they cover. Click the card to flip . co-payments), thus reducing out-of-pocket expenditure and potentially improving financial protection. Alhassan RK, Nketiah-Amponsah E, Arhinful DK. 0000010246 00000 n Due to voluntary participation, small pool size and little or no subsidization of poor and vulnerable groups, CBHI can play only a very limited role in progressing towards UHC. Sometimes, these arrangements include a purchaser-provider split. 0000079954 00000 n Article Purchasing health services for universal health coverage: how to make it more strategic? Prakongsai P, Limwattananon S, Tangcharoensathien V. The equity impact of the universal coverage policy: lessons from Thailand. WHO definition of health financing: Health financing is the function of a health system concerned with the. Territorially distinct pools have much in common with a single national pool. Hatfield (South Africa): CMS; 2016. Such pooling setups create explicitly unequal financing arrangements and the population segmentation is often further linked with separate purchasing and service provision arrangements. Under the first form, the ministry of health typically pools these funds into the health budget and allocates them to service providers, i.e. the accumulation and management of prepaid financial resources on behalf of some or all of the population; and 3) purchasing, i.e. Gottret P, Schieber G. A practitioners guide health financing revisited. Collectively, they work to meet the physical and mental health care needs of Australians. Health financing involves not only methods of raising money for health care, but also allocation of those funds. territorially overlapping pools in terms of service and population coverage; (4.) a single pool; (2.) Health Care Syst Transit. Popovich L, Potapchik E, Shishkin S, Richardson E, Vacroux A, Mathivet B. Russian Federation: health system review. In 2016, VHI expenditure represented more than 20% of current health spending in only few countries with primary or duplicative coverage (Bahamas, Botswana, Brazil, Namibia, South Africa) [29]. This limits the potential for risk pooling, as there are not enough healthy members from whom to redistribute [23]. Again, higher-income people with health lower risks and higher contributions may be in a different pool from people in low-income groups with higher health risks and lower contributions. In the absence of risk pooling, payments made for health services would be directly related to the health needs of the individual, i.e. This has an adverse impact on equity in resources across pools. In contrast, voluntary participation means that an individual or firm makes a voluntary pre-payment and enrolls on a voluntary basis in a health coverage scheme (i.e. The health financing system in the country is complex as it involves different layers of financial sources, . pooled, in one or several pools. Today, millions of people do not access services due to the cost. 0000000016 00000 n State budget transfers to health insurance funds: extending universal health coverage in low- and middle-income countries of the WHO European region. An appraisal of the health transformation Programme. hbbd``b` "$8@B\HHo \Q u 88b``g T Berkshire: Open University Press; 2005. van de Ven WP, Beck K, Van de Voorde C, Wasem J, Zmora I. RAND research explores the effects of corporate and government health care financing policies on such groups as patients, businesses, hospitals, and physician-providers. PubMed Central Results The Kenyan health sector relies heavily on out-of-pocket payments. However, evidence for efficiency improvement with increased market competition among purchasers is weak [25]. Whether this potential is actually realized will also depend on the interaction and alignment of the pooling architecture with the two other health financing functions of revenue raising and importantly purchasing. Wahshginton DC: World Bank; 2005. Compulsory participation refers to the legal requirement that someone be included for coverage and goes hand-in-hand with contributory-based entitlement, i.e. endstream endobj 155 0 obj<> endobj 156 0 obj<> endobj 157 0 obj<> endobj 158 0 obj<> endobj 159 0 obj<> endobj 160 0 obj<> endobj 161 0 obj<> endobj 162 0 obj<> endobj 163 0 obj<> endobj 164 0 obj<> endobj 165 0 obj<> endobj 166 0 obj<> endobj 167 0 obj<>stream Health financing for UHC consists of three core functions: 1) revenue raising, i.e. Supplementary insurance, on the other hand, provides enhanced access, such as a higher level of inpatient amenities or greater user choice of providers compared to the coverage in the public system [51, 55]. Due to concerns about the previous type of arrangement in many countries, various countries developed policy responses and undertook significant pooling reforms starting in the 2000s. As a consequence of this de facto voluntary arrangement, countries such as Ghana, the Philippines and Vietnam still experience inequities between the insured and uninsured population [34, 44]. This is because the overall progressivity of the health-care system is a function of the progressivity (or lack of it) of the individual sources of health-care financing. Int J Equity Health. Google Scholar. Subsidized health insurance coverage of people in the informal sector and vulnerable population groups: trends in institutional design in Asia. 0000005327 00000 n the allocation of pooled funds to health service providers [ 1 ]. Likewise, when their sizes differ across the country, they could turn out to have unequal redistributive capacities [14]. Known for its rigorous approach to solving complex challenges, Abt Associates is regularly ranked as one of the top 20 global research firms and one of the top 40 international development innovators. Three key health financing system functions Resource Mobilization: The final goals of UHC are equity in service use, quality, and financial protection. Int J Equity Health 18, 198 (2019). (accessed 5 February 2019)]. Promoting strategic purchasing Making the purchasing of health services more strategic is critical for countries to progress towards universal health coverage. there must be a specific contribution made by or on behalf of the covered person. Baeza CC, Packard TG. The Canada health transfer: changes to provincial allocations. To understand the key challenges to health systems. 0000006764 00000 n "The purpose of health financing is to make funding available, as well as to set the right financial incentives to providers, to ensure that all individuals have access to effective public health and personal health care" (WHO 2000: 95). Health financing involves the basic functions of revenue collection, pooling of resources, and purchase of interventions. endstream endobj 168 0 obj<>stream Akerlof GA. It serves multiple purposes, e.g. In someother countries that have managed to overcome different schemes for different population groups and established a unified pool for contributors and non-contributors, fragmentation remains also because much of the informal sector population is defined as non-poor and must contribute to be part of the pool. Discussion paper. Business Finance refers to corporate finance in the business world which is responsible for allocating resources, creating economic forecasts, evaluating equity and debt opportunities and many more functions within an organization. Figure 1. the mobilization of resources for the health sector; 2) pooling, i.e. 0000003726 00000 n Finally, it is important to keep in mind that while pooling reforms are needed to enhance redistributive capacity, realizing the gains set by the potential of a pooling arrangement requires more than pooling. The classification is presented in Fig. It is possible to have competition across pools, i.e. Pettigrew LM, Mathauer I. Such an unequal distribution of resources is frequently found, in that available system resources are strongly skewed to those using VHI as their primary coverage. It is voluntary because there is no legal obligation to join a scheme, and thus the person or their employer can choose not to be part of a pool for coverage [22]. Spending targets for health: no magic number. (&9~4y4no74d4J+2 ;RVbL|rSN /-`X/qggmzQV8rd pvr\HUc. 0000003940 00000 n Health Systems Financing: The path to universal coverage. Health financing is a key function of the health care system, and is a complex issue. Territorially distinct pools are found among high-income countries, including for example the United Kingdom, Spain and Denmark, as well as among low- and middle-income countries, such as Brazil. 0000008860 00000 n Abt Associates is a mission-driven, global leader in research and program implementation in the fields of health, social and environmental policy, and international development. Geneva: World Health Organization; 2019. Busse R, Blmel M. Germany. What are the four major services and healthcare? Decentralized countries often have pools organized by government administrative levels. The three basic functions of any health financing system are revenue col-lection, risk pooling, and purchasing of services. endstream endobj 788 0 obj <>/Metadata 86 0 R/OCProperties<>/OCGs[800 0 R]>>/Outlines 125 0 R/PageLayout/SinglePage/Pages 783 0 R/StructTreeRoot 156 0 R/Type/Catalog>> endobj 789 0 obj <>/ExtGState<>/Font<>/Properties<>/XObject<>>>/Rotate 0/StructParents 0/Tabs/S/Type/Page>> endobj 790 0 obj <>stream The nature of pooling by which individuals are included in pools has important implications for their redistributive capacity. Although this pooling arrangement does not fully overcome fragmentation and population segmentation, it substantially reduces it. Resource allocations also need to take into account differences in sub-national revenue raising capacity across the different territorial units [38]. It is found in several low- and middle-income countries that have started to introduce social health insurance for formal sector employees only, such as El Salvador, Guatemala, Togo and Cape Verde. The basic activities involved in financial management in healthcare organizations include evaluation and planning, long-term investment decisions, financing . Health Policy. "Health system financing is an essential component of UHC but progress toward UHC also requires coordinated actions across the pillars of the health system with particular attention to strengthening human resources for health." Health system financing health topic 14]: The World Bank; 2013 [http://siteresources.worldbank.org/HEALTHNUTRITIONANDPOPULATION/Images/MexicanSocialProtectionSysteminHealth.pdf. Bethesda: Health Finance & Governance Project, Abt Associates Inc; 2018. Where VHI coverage is unsubsidized, only those who can afford it will benefit, and inequalities will remain. World Health Organization. World Health Report 2010 Technical Brief Series - Technical Brief No. All people have in principle access to the same benefits. Multiple funds imply multiple information systems linked to each pool/purchaser that in turn may entail the need for more administrative staff at the level of providers. Contribution made by or on behalf of some or all of the health sector ; 2 ),... Provincial allocations to the cost resource allocations also need to take into account differences in sub-national revenue capacity... Often have pools organized by government administrative levels of financial sources, in sub-national revenue raising capacity across country... Of prepaid financial resources on behalf of some or all of the covered person the same benefits although this arrangement... Universal coverage revenue functions of health financing, pooling of resources for the health sector relies on! Health Finance & Governance Project, Abt Associates Inc ; 2018 same.! 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